Augusta Georgia Hospital's Worksheet D Series Comparison
The Worksheet D series has a lot of different reports. This series is for cost apportionment. There are five parts: Part I - Apportionment of Inpatient Routine Service Capital Costs
Part II - Apportionment of Inpatient Ancillary Service Capital Costs
Part III - Apportionment of Inpatient Routine Service Other Pass-Through Costs
Part IV - Apportionment of Inpatient/Outpatient Ancillary Service Other Pass-Through Costs
Part V - Apportionment of Medical and Other Health Services Costs
On the cost reports, there are expenses (Worksheets A & B) and revenue (Worksheet D). From the data reported on these series of worksheets, a cost-to-charge ratio can be derived. On Worksheet D, the hospital reports Medicare and sometime Medicaid charges. Using the cost-to-charge ratio, the cost report calculates how much cost is associated with the Medicare and/or Medicaid charges for the cost report year.
There are a lot of calculations throughout the Worksheet D series. I will highlight only a few in this post.
Per Diems
Worksheet D-1 calculates several per diems for Inpatient Routine Service Cost Centers. These per diems will give you an average of what the hospital charges for room & board for the routine cost centers.
| Service | AU Medical | University Hosp | Doctors Hosp | Burke Medical | Univ-McDuffie |
|---|---|---|---|---|---|
| Routine | 1,266 | 918 | 761 | 2,301 | 1,308 |
| ICU | 1,470 | 1,226 | 1,760 | 0 | 0 |
| Pediatric ICU | 2,504 | 0 | 0 | 0 | 0 |
| Coronary Care Unit | 1,180 | 0 | 0 | 0 | 0 |
| Burn ICU | 0 | 0 | 1,798 | 0 | 0 |
| Surgical ICU | 2,319 | 0 | 0 | 0 | 0 |
| Trauma ICU | 1,881 | 0 | 0 | 0 | 0 |
| Neuro ICU | 0 | 1,610 | 0 | 0 | 0 |
| NICU | 2,360 | 0 | 1,555 | 0 | 0 |
Routine covers departments such as telemetry, med-surg, pediatrics, and intermediate care. With this per diem being an average and coverage lots of different departments, it is a little hard to derive concrete information from this figure. BUT it is interesting that Burke Medical and University McDuffie has really high per diems. I suspect there are other revenue being reported for Burke Medical for services other than room & board on line 30. I could be wrong; the figure just is really high for adults & peds.
The coronary care unit per diem at AU Medical looks low, but as you can see ICU is general has a much higher room & board charge. This is consistent with patients in those rooms receiving a much higher level of care as opposed to a regular med-surg room.
Medicare Charges & Cost
On Worksheet D-3 and D, Pt V, Medicare and Medicaid charges are entered. Medicare and Medicaid information is reported separately. The cost report calculates how much cost is associated with the charges entered. Let’s see how that looks for each of the hospitals.
One side note: These are charges for patients with Medicare A & B only.
| Hospital | IP Chg | IP Cost | OP Chg | OP Cost | Total Chg | Total Cost |
|---|---|---|---|---|---|---|
| AU Medical | $319,022,564 | $78,235,726 | $386,660,263 | $72,400,824 | $705,682,827 | $150,636,550 |
| University Hosp | $235,049,270 | $77,064,141 | $171,279,018 | $39,092,318 | $406,328,288 | $116,156,459 |
| Doctors Hosp | $447,658,971 | $38,710,399 | $197,421,693 | $16,622,148 | $645,080,664 | $55,332,547 |
| Burke Medical | $1,172,245 | $765,505 | $2,633,528 | $956,622 | $3,805,773 | $1,722,127 |
| Univ-McDuffie | $3,485,011 | $1,434,200 | $10,311,450 | $2,592,579 | $13,796,461 | $4,026,779 |
This is our first look at Medicare charges and what the cost report calculates it cost the hospital to provide these services. In the Worksheet E series, we’ll take this one more step and see what the hospital was paid versus what it cost them to provide the services.
Medicaid Charges & Cost
Let’s take a look at the same information as about except this data is just for patients with traditional Medicaid - no HMO plans included.
| Hospital | IP Chg | IP Cost | OP Chg | OP Cost | Total Chg | Total Cost |
|---|---|---|---|---|---|---|
| AU Medical | $139,279,455 | $40,134,604 | $106,407,175 | $21,425,474 | $245,686,630 | $61,560,078 |
| University Hosp | $41,825,633 | $14,896,581 | $9,796,815 | $2,482,741 | $51,622,448 | $17,379,322 |
| Doctors Hosp | $120,009,787 | $11,772,538 | $22,090,100 | $1,896,056 | $142,099,887 | $13,668,594 |
| Burke Medical | $282,452 | $176,423 | $735,123 | $220,251 | $1,017,575 | $396,674 |
| Univ-McDuffie | $1,297,036 | $575,814 | $2,487,333 | $550,006 | $3,784,369 | $1,125,820 |
Since this information doesn’t include non-traditional Medicaid plans, it doesn’t give us the whole vision of how much Medicaid services are provided. But it’s a start. And it’s what we have.
Musing Revelation
There is so much more information provided in the Worksheet D series than what I covered above. I didn’t begin to scratch the surface. It is interesting to see how much traditional Medicare and Medicaid services each hospital is providing and to see how their charges relate to their cost.
Room rates (per diems) are always fascinating to me. It gives a sense of how much the hospital is charging just to house you overnight. That bed really does come at a premium.
Next time we’ll take a look at the Worksheet E series. These worksheets will allow to take this information just one step further. We will see just how much Medicare pays these hospitals vs what the cost report calculates it cost them to provide the services. Join me as we continue to learn all we can about these hospitals from their Medicare Cost Reports.
University Hospital Worksheet D series
Doctors Hospital Worksheet D series